Perioperative nutrition optimization:a review of the current literature

Objective:This article aims to elaborate the recent research status of perioperative nutrition optimization,in order to help clinical practice.Methods:This study employed a comprehensive and systematic method to search prominent databases,including PubMed and Web of Science,using carefully selected keywords.Following meticulous screening,the inclusion of high-quality studies was prioritized,and a thorough review of the references was conducted to comprehensively analyze the latest evidence on perioperative nutrition optimization.Results:The main contents include preoperative nutritional risk screening and assessment,nutritional support pathway,immune enhancing nutrition,preoperative and postoperative nutritional management,as well as personalized nutrition optimization strategies for specific populations(such as children,bariatric surgery patients,and cancer patients).Conclusions:In clinical practice,the importance of perioperative nutrition should be emphasized,and personalized nutrition management plans should be developed based on the characteristics and needs of patients.Further research and promotion of perioperative nutrition optimization strategies will help improve the overall prognosis and quality of life of surgical patients.

Effects of enteral immunonutrition on immune function in patients with multiple trauma

BACKGROUND：Enteral immunonutrition （EIN） refers to addition of some specific nutrients in enteral nutrition （EN）, which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients. METHODS：Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups： an enteral immunonutrition group （EIN group, n=16） and an enteral nutrition group （EN group, n=16）. EIN suspension （RuiNeng produced by Sino-Swed Co., Ltd） and ordinary nutrition liquid （RuiSu produced by Sino-Swed Co., Ltd） were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count （TLC）, immunoglobulin （IgG, IgM, IgA）, and T-lymphocyte subsets （CD3, CD4, CD8, CD4 / CD8） were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support. RESULTS： TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day （P〈0.05）, and continually increased with a prolonged time of EIN. The parameters of immune function in the EN group on the 7th day didn＇t change significantly compared with those on the 1st day after grouping; on the 14 th day, TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher than those on the 1st day after grouping （P〈0.05）, but were significantly lower than those in the EIN group on the 14th day （P〈0.05）. CONCLUSION： Compared with the general formula EN, EIN is more helpful for the recovery of humoral and cellular immune function in the early post-multitraumatic phase.

Effect of Postoperativeω-3 Fatty Acid Immunonutritional Therapy on NK Cell Gene Methylation in Elderly Patients with Gastric Cancer

Objective This study aims to investigate the effect ofω-3 fatty acid immunonutritional therapy on natural killer(NK)cell gene methylation and function in elderly patients with gastric cancer.Methods A total of 70 cases of elderly patients with gastric cancer were randomized into theω-3 fatty acid group and placebo group,according to the type of nutritional support administered.The methylation status of the tumor necrosis factor(TNF)-αgene promoter in peripheral NK cells was detected by methylation specific polymerase chain reaction,and the TNF-αlevel in peripheral NK cells was detected by enzyme-linked immunosorbent assay.Results After 14 days of immunonutritional therapy withω-3 fatty acid or placebo,patients in theω-3 group had significantly higher average NK cell activity(0.27 vs.0.24,P=0.013)and lower percentages of TNF-αgene promoter methylation(25.7%vs.60%,P<0.05)than the placebo group.However,there were no significant differences in the concentration of albumin,prealbumin and TNF-αin serum,and the NK cell count between theω-3 group and placebo group.Conclusion The postoperative application ofω-3 fatty acid may improve the activity of NK cells,which is correlated to the methylation status of the TNF-αgene promoter.

Nutritional stimulation of the autonomic nervous system

Disturbance of the inflammatory response in the gut is important in several clinical diseases ranging from inflmmatory bowel disease to postoperative ileus. Several feedback mechanisms exist that control the inflammatory cascade and avoid collateral damage. In the gast rointestinal tract, it is of particular importance tocontrol the immune response to maintain the balance that allows dietary up take and utilization of nutrientson one hand, while preventing invasion of bacteria and toxins on the other hand. The process of digestion and absorption of nutrients requires a relative hyporesponsiveness of the immune cells in the gut to luminacontents which is not yet fully understood. Recentlythe autonomic nervous system has been identifi ed asan important pathway to control local and systemic inflammation and gut barrier integrity. Activation of thepathway is possible via electrical or via pharm acological interventions, but is also achieved in a physiologicamanner by ingestion of dietary lipids. Administration of dietary lipids has been shown to be very effectivein reducing the inflammatory cascade and maintaining intestinal barrier integrity in several experimental studies. This beneficial effect of nutrition on the inflammatory response and intestinal barrier integrity opens new therapeutic opportunities for treatment of certain gastrointestinal disorders. Furthermore, this neural feedback mechanism provides more insight in the relative hyporesponsiveness of the immune cells in the gut. Here, we will discuss the regulatory function of the autonomic nervous system on the inflammatory response and gut barrier function and the potential benefit in a clinical setting.

Review of Research on Immunotherapy of Severe Surgical Infection

Severe surgical infection refers to infection after surgical treatment or surgical operation,accounting for approximately 30% of surgical diseases. This type of infection can cause extensive inflammation and tissue injury and reduce success rate of surgical treatments.Immune defense plays an important role in antiinfection treatment of hosts. Infection immunity is a series of physiological defense mechanisms for recognition of immune system and removal of pathogens. As for severe surgical infection, immunotherapy becomes an important and promising therapy for severe surgical infection. This study summarizes recent progresses achieved in immunization and immunotherapy of surgical infection.

A Tool for the Treatment of Gastrointestinal Tumors: Micro- Ecological Immunotherapy

It has been proposed that the intestinal microbiota and gastrointestinal tumors are interdependent.Changes in the microbiota can cause dysfunction of the gastrointestinal tract,thereby promoting carcinogenic changes,leading to the occurrence of gastrointestinal tumors.Recent studies on intestinal microbiota have opened up a new area in intestinal micro-ecological immunotherapy.The intestinal microbiota is a double-edged sword.Gut microbes participate in carcinogenesis,but can also be used for immunotherapy.The intestinal microbiota is also regulated by the daily diet.Intestinal micro-ecological immunotherapy combines intestinal immune nutrition and intestinal ecological nutrition to make full use of the intestinal microbiota to strengthen nutritional support.Micro-ecological immunotherapy enhances the body’s immune function by providing energy,improving the functional state of tissues and organs,protecting the intestinal mucosal barrier and maintaining normal intestinal microbiota balance.This involves,to some extent,PD-1 and PD-L1.The microbiota is beneficial to improve the clinical efficacy of conventional anti-cancer therapy and to reduce the incidence of complications.At the same time,micro-ecological immunotherapy is itself active and effective in the perioperative treatment of tumors,which is of great significance for the prognosis of the patient.Gastrointestinal tumors are increasingly linked to intestinal microbiota,and various microbiota-related technologies and drugs have been developed.In the future,the intestinal microbiota may represent a screening marker for gastrointestinal tumors.In addition,clinicians may be able to prevent and treat cancers by changing the gene expression levels of certain microbiota,or by regulating the types of microbes present.

Effects of postoperative immune-enhancing enteral nutrition on the immune system,inflammatory responses,and clinical outcome

Objective This study was conducted to evaluate the effects of postoperative immune enhancing enteral nutrition on the immune system,inflammatory responses,and clinical outcome of patients undergoing major abdominal surgery. Methods This study was designed as a multicenter,prospective,randomized and controlled clinical trial. One hundred twenty-four patients undergoing major abdominal surgery were randomly assigned to receive either an immune enhancing enteral diet or an isocaloric and isonitrogenous control enteral diet for seven days. Enteral feeding was initiated 24 hours after surgery. Host immunity was evaluated by measuring levels of IgG,IgM,IgA,CD4,CD8,and CD4/CD8,and the inflammatory response was determined by assessing IL-1α, IL-2, IL-6, IL-10, and TNF-α levels. Infectious complications were also recorded. Results One hundred twenty patients completed the study and four patients were excluded. On postoperative day 9,among patients receiving an immune enhancing diet,IgG,IgA,CD4 and CD4/CD8 levels were significantly higher and TNF-α and IL-6 concentrations were significantly lower compared to the control group. Moreover,among patients receiving an immune enhancing diet,when comparing preoperation to day 9 postoperation levels,increases in IgA,CD4,and CD4/CD8 levels were significantly higher than in control patients and increases in TNF-α concentrations were significantly lower. No statistically significant differences were found between the two groups with regard to infectious complications. Conclusions Postoperative administration of immune enhancing enteral nutrition in patients undergoing major abdominal surgery can positively modulate postoperative immunosuppressive and inflammatory responses.

Interplay between gut microbiota and antimicrobial peptides

The gut microbiota is comprised of a diverse array of microorganisms that interact with immune system and exert crucial roles for the health.Changes in the gut microbiota composition and functionality are associated with multiple diseases.As such,mobilizing a rapid and appropriate antimicrobial response depending on the nature of each stimulus is crucial for maintaining the balance between homeostasis and inflammation in the gut.Major players in this scenario are antimicrobial peptides(AMP),which belong to an ancient defense system found in all organisms and participate in a preservative co-evolution with a complex microbiome.Particularly increasing interactions between AMP and microbiota have been found in the gut.Here,we focus on the mechanisms by which AMP help to maintain a balanced microbiota and advancing our understanding of the circumstances of such balanced interactions between gut microbiota and host AMP.This review aims to provide a comprehensive overview on the interplay of diverse antimicrobial responses with enteric pathogens and the gut microbiota,which should have therapeutic implications for different intestinal disorders.